Published Online
on March 22, 2007

A more recent version of this article appeared on May 1, 2007

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Submitted on September 26, 2006
Revised on November 27, 2006
Accepted on December 11, 2006

Carotid Intraplaque Hemorrhage Predicts Recurrent Symptoms in Patients With High-Grade Carotid Stenosis

Nishath Altaf MRCS(Ed)^*; Shane T. MacSweeney FRCS; John Gladman FRCP; and Dorothee P. Auer PhD

From the Department of Academic Radiology (N.A., D.P.A.), University of Nottingham, Queen’s Medical Centre, Nottingham, UK; the Department of Vascular and Endovascular Surgery (N.A., S.T.M.), Queen’s Medical Centre, Nottingham, UK; and the Division of Rehabilitation and Ageing (J.G.), University of Nottingham, Queen’s Medical Centre, Nottingham, UK.

^* To whom correspondence should be addressed. E-mail: nish.altaf{at}nottingham.ac.uk.

Background and Purpose--Carotid intraplaque hemorrhage (IPH), known to be associated with plaque instability, may convey a higher stroke risk. The aim of this study was to assess whether the identification of IPH by MRI predicts recurrent clinical cerebrovascular events.

Methods--Sixty-six patients with high-grade symptomatic carotid stenosis underwent MRI of the carotid arteries and were followed until carotid endarterectomy or 30 days.

Results--Of the 66 patients with a median follow up of 33.5 days, 44 (66.7%) were found on MRI to have ipsilateral carotid IPH. Fifteen recurrent events were associated with ipsilateral carotid IPH. Only 2 recurrent events occurred in the absence of IPH. IPH increased the risk of recurrent ischemia (hazard ratio=4.8; 95% CI=1.1 to 20.9, P<0.05).

Conclusion--IPH as detected by MRI predicts recurrent cerebrovascular events in patients with symptomatic high-grade carotid stenosis.

Key words: carotid artery disease • ischemia • magnetic resonance imaging

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